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SITE ADDRESS <br />LEGAL LOT N0. <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�ARCEL TAJ( LU. # <br />BLOCK TRACT <br />AODRESS <br />. , ;'i���, . . <br />I CONTACT FOR PERMIT <br />CONTRACTOR � �� �fy;� ,��,_ � �, ��� (. <br />PHONE , .;/.��, ;���� , ,rjF, . <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PERMIT <br />TYPE <br />ADDRESS <br />: �,;� ; �//�i �1,.r �� l <br />�,. �.,1 � ;� � <br />Building n Mechanical <br />Combination �� Plumbing <br />Demolition D Sign <br />. , Sprinkler <br />�� ; t�/ G' <br />1 �, i s � <br />NO. I TYPE OF FI%TURE OR ITEM <br />�I <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHUW ER <br />KITCHEN SINK 8 DISPOSAL <br />�ISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEIBAWM1IOPIETC.) <br />OTHER <br />ZIP <br />l.� ) l � <br />y � l� -o <br />PERMIT k I <br />�K�y�3.� i <br />I <br />PHONE <br />PHONE <br />CONTR. LICENSE # <br />�?t-i> �•_ i..�,{' : .: � _�.'. <br />Atldition <br />WORK Alteration <br />TYPE ' New <br />Repair�Maint. <br />HEATSOURCE <br />�] Electnc <br />�� Gas <br />U Other <br />CITY OF EVERETT LOCAL SALES TAX COUE IS no5 <br />/�.�� i:- �' i r �. "� ir- <br />n e ��. Ci,i' <br />NO. I TYPE OF PIXTURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />�.. �' t a A' S <br />' �1EREBV CI=RITIFV THAT I HAVE fiEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />i'ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEFEIN OR <br />VOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTNcR <br />STFTE OR LOCAL LAW REGULATING CGNSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BV THL <br />OWNER OF -HIS PROPERTY TO PERFOft�1 THE WORK FOR l4'HICH APPLICATIJN IS MADE AND I COM1IPLY WITH THE STATE <br />CONTRACTGRS LAbV /0.27 RCW AND 296.200 WAC. <br />., I I ./�l %�/�>� (U• <br />�. Si9nalure of OwnenContraclonnumonzaa Ngem ���� (/ <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED Z <br />